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General NPI Number Information
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NPI Number | 1679640197
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Entity Type | Organization
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Legal Business Name | ELMHURST APOTHECARY, LLC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1018 ELMHURST BLVD
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City | CONCORDIA
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State | KS
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Zip | 66901-3900
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Country | US
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Telephone | 785-243-9796
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Fax | 785-243-1827
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Provider Business Mailing Address
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Address Line | 1018 ELMHURST BLVD
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City | CONCORDIA
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State | KS
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Zip | 66901-3900
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Country | US
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Telephone | 785-243-9796
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Fax | 785-243-1827
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Authorized Official
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Title or Position | MEMBER
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Name | MR. DOUGLAS L FUNK
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Credential | R.PH.
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Telephone | 785-243-9796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 2-09818
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License Number State | KS
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